How should I manage a patient with a confirmed extradural haematoma who is stable but requires monitoring?

Management of a clinically stable patient with a confirmed extradural haematoma who requires monitoring:

• Admit the patient to hospital under the care of a consultant-led team trained in managing head injuries and neurosurgical conditions to ensure competent assessment and observation ¹.
• Discuss the case with a neurosurgeon promptly, as extradural haematoma is a surgically significant abnormality on imaging and requires specialist input for ongoing care and potential intervention ¹.
• Perform and document neurological observations at minimum half-hourly intervals until the Glasgow Coma Scale (GCS) score is 15, including pupil size and reactivity, limb movements, respiratory rate, heart rate, blood pressure, temperature, and oxygen saturation ¹.
• Once the patient has a GCS score of 15, reduce observation frequency to half-hourly for 2 hours, then hourly for 4 hours, then every 2 hours, reverting to more frequent observations if any deterioration occurs ¹.
• Use a standardised head injury proforma for documentation throughout the hospital stay to ensure consistent and thorough monitoring ¹.
• Be vigilant for any signs of neurological deterioration such as a drop in GCS, new focal neurological signs, seizures, or other complications, and escalate care immediately if these occur ¹.
• Consider the risk of hypopituitarism after head injury and investigate if symptoms or biochemical abnormalities (e.g., low sodium or blood pressure) develop during admission or follow-up ¹.